TRADES
Application #
Mail In application
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
will complete the jfiah(ffil(Nj- J&2)L work on the project or
(Name) (Trade)
structure herein described. My state license number is All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: le 0" Yin -J- It?, rc,
Mailing Address: ~Ja
Street Address: I F /
Business Phone: Email Address: ~C,~ [ a:~HV1gL6)(V
'Name, address, & phone must match information on license.
Owner' Name: /arJa _Rn-{-hmO Job Information Phone II U- ~1 "J ~JV~
Construction or Site Address:-7D 5_a4 fla Vtl I i n 1 F U Vi CDP - L bi
S ecific Directions to Job from Lillin ton:
Description of work to be done: n( Ir r( 00 Dyll"'L
Mechanical: New Unit With Ductwork _ Jew Unit Without Ductwork G s Piping _ _NZ Electrical: 200 Amp _ <200 Amp - Service Change _ Service Reconnect _ Other
Plumbing: Water/Sewer Tap - Number of Baths _ Water Heater
Job cost of work to be done:.A_U~.
eo Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ (Q tx~
Make check payable to: Harnett County Central Permitting (HCCP)
---Mail completed application form to: Harnett County Central Permitting - - - - - -
PO Box 65
Lillin ton, NC 27546
Contractor's Signature: Date:
DO NOT SEND CASH. INCOMPLETE LICA IONS WILL NOT 8 PROCESSED.
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